200B-073-002
Tommy Oliver, 19 years old, came to St. Clement's Drug Unit last year. Using another addict's needle, he contracted hepatitis. He was hospitalized for treatment, stayed there six weeks, came off drugs completely and then went into the army. Discharged for flat feet, Tommy is back on drugs, and he is back at St. Clement's.

The deadly drug flowing to this boy's heart is legal stuff. As a registered heroin addict, he gets it, along with encouragement and advice, through a clinic. The program, two years old, is aimed at stopping the spread of the habit. With heroin use growing fast in the U.S., we may learn from the British experiment.

200B-073-013
Eighteen-year-old June Frewer has just tasted an addict’s destructive ecstay-a fix. Soon she will slouch, then sleep on the chair. One of 13 children, she says her mum “spends a lot of time in court; one of us is always in trouble.” June, who lives in the Brick Lane red-light district, moved up fast from cannabis (pot) to purple hearts (phenobarbital) to horse (heroin).

200B-073-011
For Roy Burrell, 21 (left), the object is “to make the kick last”. Raymond Shad, 19 (right), like all the St. Clement’s addicts, started on marijuana with his “mates”. The stocking serves as a tourniquet to make a depleted vein pop out ready for injection. He also playfully hangs the stocking like a noose from the light.

The room is small. Two holes carved out by angry, fists punctuate the institutional gray walls. The floor is also gray, and littered with cigarette butts. In one comer stands a steel sink. The rest is bare, except for a roll of blood-spattered toweling, three chairs and a refuse can. From the single window, there is a view of tenement's black with centuries of East End coal dust. Sun pokes through smog-sodden clouds. This place has a no-nonsense name, a low-class address: The Fixing Room, St. Clement's Hospital Drug Unit, Bow Road, London. From hour to hour, the faces change, but they are always young. Their color matches the room's. Born--in the white Harlem of London, with the stench of the Industrial Revolution in their nostrils, these kids are unhealthy, mostly because they are on hard drugs. They come to this room to shoot "horse." They are heroin addicts.

200B-073-006
Jimmy Latimer registered as an addict in April, 1968, at age 21. His first dose: one-and-one-half grains of heroin, the same of cocaine. The veins in his arms are so tired, he shoots in his hand. But now he is working part-time and has come down in his dose: hall a gram of cocaine, ten milligrams of methadone. This spring, clinics will stop giving cocaine.

200B-073-005
Julie Bailey graduated from “soft” to “hard” drugs when her lesbian friend went to jail for possession of illegal heroin. Both prefer the privacy of St Clement’s ladies’ room for shooting. Julie’s “girl friend” gave her a puppy and eyelashes for her birthday. “They have”, says psychiatrist Dr. Margaret Tripp, “the most stable relationship of any of my patients.”

200B-07X-01X
Relief for addicted Carol Hammersley, 26 (center), is a fix. She ‘tripped out” and left a needle in her arm that had to be surgically removed. Joseph Wakeman (left) registered in August, 1968, after his brother-in-law had turned him from hash to heroin. Roy Burrell (right) has come down to ten milligrams of heroin and ten milligrams of methadone.

Outside the fixing room is a commons room that looks like settlement-house American. Un-uniformed nurses and social workers -in mini-skirts, male nurses in business shirts, and a senior psychiatrist, female, in net stockings and boots, stand around. There's no hospital bustle, no ward quiet. From addicts who aren't turned on to soporific ease, there's chat, some of it hostile, some of it hopeful. The staff suffers the hostility and the foul language of London's steamy East End. They work to instill confidence, and listen, listen. "How's your dog.?" "Is the new job any better?" "Where were you at painting class? We missed you." "I see you're down another 'jack," great." Over Ping- Pong or hot lunch, there may be a breakthrough. It may seem vague, this sort of treatment, but St. Clement's addicts have been going back to work. In the first two years of the program, all of them are coming down, and some have even come off drugs.

200B-073-012
For Vincent Purcell, 20, there's some hope. He went, from pot to purple hearts to heroin-he's been on that for three years. But because he's a skin popper (intramuscular injections), he's not so seriously addicted. He says he'd like to leave his job as a warehouse laborer. "I want to take a cold-turkey cure," he dreams, "then I'll become a hairdresser or an electrician."

Free drugs, free psychotherapy and social work exist at the outpatient drug unit of St. Clement's Hospital only because the British got scared. In 1965, the Brain Committee of Parliament reported that in the previous five years there had been a steady increase in the number of heroin addicts and a steady decrease in their ages. It found that a handful of doctors were over- prescribing heroin to addicts, and that the addicts were selling what they didn't need on the black market. The committee recommended measures to prevent over-prescribing and to make legitimate supplies available to addicts. In 1967, the government acted. It took the right to prescribe heroin for drug addicts away from general practitioners and gave it to drug-treatment clinics. Now, to obtain heroin legally, British heroin addicts register with a clinic. Some pick up their daily doses, prescribed by their clinics, at a neighborhood pharmacist and inject themselves. Others have to get their heroin directly from the clinic.

There are 13 heroin clinics in the Greater London area. Each has psychiatrists and social workers, but that is where the likeness ends. "The ways the clinics work," says Dr. A. A. Baker, who heads the drug program from the Ministry of Health, "are different, and they want, at least for a while, to keep it that way. One clinic has the staff doing the injections. We think that there is-a lot of truth in the theory that many addicts are really addicted to the needle, to the kick, often a sexual surrogate, of injecting themselves or someone else. Having staff do the injections is a good way of handling it, but it really can only work with the unemployed addict.

All the clinics report that a large proportion of their addicts are going back to work and causing fewer family and community problems. Only a long-term follow-up will show whether the number of new heroin addicts is going down or not."

St. Clement's Drug Unit is more a community center than any of the other London clinics. In addition to prescribing heroin, ten nurses, two social workers, one full-time and two part-time psychiatrists spend their day chatting with addicts, helping them find jobs, talking to their families, pharmacists and probation officers, visiting addicts hospitalized with infections, and giving lectures on drugs. Dr. Margaret Tripp, a peppy, curly headed, no-nonsense 40-year-old mother of three, heads the unit. She left a post in one of Britain's leading mental hospitals to take on .the unit job. "I came here at a time in my life when I no longer needed to feel that I'd cured someone," she said. "Now I just accept that I've learned about another segment of society, one I wouldn't have known otherwise. But I also know that when Iam dispensing heroin, I'm prescribing a killer drug. I tell this to the kids too. When they say they want help, I tell them that what they really want is heroin ... not help."

On April 16, 1968, the day when general practitioners could no longer legally prescribe heroin for drug addicts, St. Clement's Drug Unit opened officially. Initially, Dr. Tripp took 100 comers, but she also referred more than 250 to other clinics. The group now comes mostly from the immediate down and-out East End area.

"It's hard to know what to do about some of them when they come to register. With a hard-core addict of 21, it's obvious. He's come to get drugs on the cheap, and I make a kind of contract with him-he will get drugs, and I will help the part of him that wants to come off. But when kids come in who aren't hard-core addicts, kids who have only one or two fix marks, I have to decide whether, if I take them, I'll turn them into addicts by giving them drugs, or whether, if I turn them away, they'll go to the black market and come back in weeks addicted."

Unless addicts ask for private appointments, Dr. Tripp and her assistant psychiatrists try to see them -informally in the commons room. There's no 50-minute hour, but snatchings for friendships, serious talk of jobs and family, and always of "coming down." Margaret Tripp reviews dosages frequently. She cancels prescriptions if addicts don't show up at least once a week for therapy, if they forget prescriptions, or if they don't take a job when she feels they are ready.

The atmosphere at St. Clement's is not clinical. The eight female nurses, all in their early twenties, and two older male nurses, are enthusiastic about the work. Most have had some psychiatric training. No one wears a uniform. Over lunch (about 20 addicts show up each day for a free lunch), playing Ping-Pong, or slouched in a corner of the commons room, nurses are constantly working to get close to the addicts. In this relaxed atmosphere, addicts readily admit when they've gotten black market drugs. They talk easily about their homes, their sexual hang-ups. The nurses and caseworkers make home visits. Dr. Tripp and a social worker helped Vincent's family get public housing. "His brothers and sisters were sleeping in his room. They learn fast . . . " she pointed out, "now he has his own room."

Group therapy has achieved some success at the clinic, particularly with hippies-middle-class dropouts. "It's harder with adolescent boys from the lower class. They don't like to discuss their feelings with adults," says Dr. Tripp. "Most of these addicts do not have solid relationships. The most solid one is between two lesbians who have been “married” and faithful for two years."

Does the British system seem to be working? When I asked Dr. Tripp that question, she gave me a measured answer. "It depends on your aims. Ours were to control the spread of heroin addiction and control the amount of heroin on the market. In this regard, we've been successful I believe. I've seen only a few new cases of heroin addiction. We have seen a spread to methadone and barbiturates. I think it is an improvement if heroin is replaced by methadone but not if it's replaced by barbiturates.

"Our Old Bill [the police] are sympathetic to our problems. The drug unit of the Home Office is marvelous. They have great understanding of the psychiatric sickness of addicts. They don't regard them as criminals."

Patience and cool are only part of a solution. The British attitude is that to find answers, you have to pay for experiments. They've legalized the drug, taken the addict off the street, put him to work at least part-time, and faced the fact that his disease may be contained but perhaps not cured.